RISE SAFELY in remote Australia - Redesigning maternity services for First Nations mothers and babies living in Central Australia, Northern Territory (NT), using Birthing on Country principles and the RISE implementation Framework, to address preterm birth and health outcomes: A prospective, non-randomised, intervention trial.

A 'Birthing on Country' service will be established in Mparntwe, Alice Springs, Central Arrernte Country, Central Australia, Northern Territory (NT) a remote, demonstration site . We will partner with key stakeholders through our community-based Participatory Action Research (PAR) approach to redesign a remote maternity service and increase support for First Nations women in both the primary and tertiary setting. Key components of the intervention include: - Multi-agency Partnership Committees and working parties providing culturally responsive overarching governance and leadership of redesign of maternity services and research, community engagement in co-designing care interventions. - Antenatal care is provided at the Alukura Hub or woman’s home, other Congress clinics or location of woman’s choice by a named (primary) midwife in collaboration with the Alukura GP and ASH antenatal services. Alukura maternity services work in partnership with ASH Diabetes AnteNatal Care and Education clinic (DANCE) to support women with diabetes. DANCE provides specialist input in care of the women. Congress Alukura midwives, GP and diabetes nurse educator (DNE) meet weekly with ASH DANCE staff. Assist women with monitoring blood glucose levels (BGL), provide medication and testing supplies and education about self- management. - Antenatal care interventions using First Nations knowledges will be co-designed to address modifiable preterm risk factors. This will be determined by the Congress Women's Health Committee and may include hunting trips, cultural camps, cultural days and other activities. Co-design will be lead by the Congress Women's Health Committee and Elders who attend weekly cultural days working in partnership with the Alukura and My Midwives teams, the hospital services and the research team. We may also have annual or biannual Women's Camps where further guidance is provided. Activities will occur after deep listening activities that enable guidance from the Elders. - Midwives follow the Australian College of Midwives National Midwifery Guidelines for Consultation and Referral and use the CARPA Minymaku Kutju Tjukurpa Women’s Business Manual as a guide for practice. When women are Categorised as B, midwives consult with the GP obstetrician at Alukura or the specialist at ASH. When women are Category C, midwives consult with the specialist at ASH to plan a specialist antenatal appointment and ongoing care however women will continue to receive continuity of care by their named midwife and receive specialist input as required at Alukura or ASH (E.g. telehealth appointments with DANCE clinic and input from DNE). - Women have 24/7 phone access to a known midwife. - A midwifery group practice (Midwifery group practices are well described in Australian maternity literature) will be established at Alukura (AMGP) where midwives work in partnership with the Congress support services with weekly teleconference to the remote teams if women are transiting between remote and urban. All women are cared for during labour from a known midwife with support from ASH staff as required. Postnatal care in hospital primarily provided by ASH staff. Teleconferences will be used as needed to discuss clinical priorities, undertake continuous quality improvement, deliver professional development, and review barriers/challenges. - After birth, when the women and baby return to the community, the midwife and Congress support services provide postnatal care up to 6-weeks. Postnatal care is delivered according to need and usually includes regular visits up to 6-weeks postnatal where mother and baby are supported with breastfeeding, care of the newborn (bathing, sleeping, settling) and other postnatal activities in line with the CARPA guidelines. - Verbal and written handover of care for every transfer between services (AMGP to or from ASH or remote and to child health services). - Women are referred to Congress support services (e.g. Australian Nurse Family Partnership team [ANFPP] and Intensive Family Support Service [IFSS] if they meet the criteria). Aim is to grow the Family Support Workers to ensure each midwife is working side-by-side with a Congress Family Support Worker who provides social and emotional wellbeing and practical support to all women across the maternity journey (if not accessing other services). Aim is to recruit and embed 2-student midwives into this service. - Frontline staff are provided with clinical mentoring and reflective supervision with a focus on clinical and cultural safety, effective intercultural communication, and working together. - A community-based hub provides a culturally responsive and safe place for women, families, caregivers and Elders to undertake cultural activities that allow connection, sharing and learning from each other within a strength-based approach to birthing and parenting. Community days will occur once a week with all women encouraged to attend. - Strategies to monitor adherence to the intervention will be through patient medical records. - The duration of the intervention will be commencing in September 2023 and ongoing as a sustainable service after data collection ends.